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DIOXINS AND ENDOMETRIOSIS: COHORT STUDY OF WOMEN IN WEST VIRGINIA
Diliberto, J J., Staats, Dee Ann, L. Sirinek, J Becker, D. J. Jude, S. Chouinard, T. Smith, G. C. Clark, R. B. Landy, AND L S. Birnbaum. DIOXINS AND ENDOMETRIOSIS: COHORT STUDY OF WOMEN IN WEST VIRGINIA. Presented at 24th Inter. Symp. on Halogenated Environmental Organic Pollutants and POPs, Berlin, Germany, Sept. 6-10, 2004.
Kanawha Valley of West Virginia has a history of 2,3,7,8-tetrachlorodibenzo-p-dioxin contamination (dioxin, TCDD). The bulk of the dioxin found in this area appears to be derived from the production of 2,4,5-trichlorophenoxyacetic acid (2,4,5-T) and the disposal of associated wastes. The 2,4,5-T was produced between 1948 and 1969 in the Kanawha Valley; during the years of production, the waste containing high concentrations of dioxin was deposited in several waste sites throughout the Kanawha Valley. More than thirty years after production of 2,4,5-T was stopped, the USEPA has found that dioxin still resides in the soils, sediments, groundwater, and river water in portions of the Kanawha Valley. High levels of the toxic dioxin have been detected in the Kanawha River and at outfall locations on the river. Dioxin has been also identified in other water bodies downstream, including hundreds of miles of the Ohio River.
The women in this endometriosis/dioxin health study reside in the Kanawha/Ohio River Valley area of West Virginia and comprise a potential cluster (cohort) of individuals who have been exposed to dioxins (dioxin and dioxin-like chemicals) at background levels higher than those seen in other areas of the United States. The emissions from an unique constellation of chemical industries appear to have led to high levels of environmental dioxin contaminants. In addition, this area has a high incidence of endometriosis. Previous animal studies, both in nonhuman primates and rodents, have demonstrated a correlation between dioxin exposure and endometriosis1-6. Human epidemiology studies have suggested an association but have not demonstrated a statistically significant correlation, possibly due to limitations in study design such as insufficient numbers, measurement of only TCDD rather than total equivalents to TCDD (TEQs), and/or lack of surgical ascertainment of endometriosis. The present study is addressing these issues. Thus, we have the unusual congruence of identified emission sources and high background levels of dioxins and a potentially related elevation of endometriosis.
Endometriosis is a condition suffered by women in which the endometrial tissue, that usually lines the uterus, migrates to other areas. Most commonly it is found in the abdomen, bladder, ovaries or bowel. Patients with endometriosis experience pelvic pain, irregular bleeding, infertility and other problems. Immune suppression has been associated with severe endometriosis7. This debilitating condition is a poorly understood disease. In the United States, this condition affects millions of women in their reproductive years and is showing up more frequently in very young women. Endometriosis will seriously impact future fertility and health care utilization. Data suggest that the rate of endometriosis in the Kanawha and Ohio River valleys is higher than is seen in other regions of the country.